Tag Archives: Health Care

The National Volunteer Fire Council (NVFC) has partnered with the EMS attorneys at Page, Wolfberg & Wirth to offer an exclusive free webinar for NVFC members on the impact that recent changes to HIPAA will have on volunteer EMS providers. This webinar would typically cost $149, so take advantage of this free offer! The webinar will take place Thursday, June 27 from 2-3:30 EDT. View flyer or register now.

Register for Webinar on New HIPAA Regulations that Impact Volunteer EMS Providers

[This article was prepared exclusively for the NVFC by the Attorneys at Page, Wolfberg & Wirth, LLC – The National EMS Industry Law Firm®. Visit their web site at www.pwwemslaw.com.]

On January 25, 2013, the U.S. Department of Health and Human Services (HHS) published a long-awaited Final Rule, implementing sweeping changes to the Health Insurance Portability and Accountability Act (HIPAA). The Final Rule grants patients new rights regarding their health information, modifies the standard for HIPAA breaches, ramps up HIPAA enforcement, and makes a host of other changes that will affect HIPAA-covered EMS agencies. Organizations have untilSeptember 23, 2013, to comply with the changes.

To help the nation’s volunteer and combination department EMS providers better understand these issues and the practical implications of the new HIPAA regulations, the National Volunteer Fire Council (NVFC) and the EMS attorneys at Page, Wolfberg & Wirth (PWW) are hosting an exclusive webinar on June 27 from 2-3:30pm EDT for NVFC members at no cost (a $149 value!). During this webinar, we will tackle the big questions for volunteer agencies and go into detail about how to grant the new patient rights, how to conduct a breach risk assessment, the changes you need to make to your business associate agreements and notice of privacy practices, and much more!

PWW has guided EMS agencies nationwide through HIPAA compliance since day one and now our attorneys are here – exclusively for NVFC members – to tell you what the new 2013 regulations mean for your EMS or fire service organization. NVFC members can register for this free webinar by clicking here. If you are not already a member of NVFC but would like to participate in this webinar, click here to join.

Click here to learn more about the big questions volunteer organizations are asking, which will be addressed in the webinar.

It would seem to me that when receiving mixed messages about storm strength, one should err on the side of resident safety. People may second guess your having evacuated but the alternative is this. Just sayin’.

The city health commissioner, Dr. Thomas A. Farley, said he and Dr. Shah believed the storm was weakening and would be no worse than Tropical Storm Irene when they made the initial decision not to evacuate the health care facilities on Friday, Oct. 26, three days before landfall. At that point, there would have been ample time to carry out a full and well-organized evacuation of the nursing homes and adult homes, which would have taken at least two days.

While the National Hurricane Center in Miami had warned of “historic urban flooding” in New York City, local National Weather Service officials issued contradictory public advisories on Friday and early Saturday that said there would be only “moderate flooding.”

Inside the city’s emergency management center, the local weather officials reported that the storm surge would be similar to the one during Tropical Storm Irene — four to eight feet.

An eight-foot surge was an important marker:after Tropical Storm Irene, Dr. Shah and Dr. Farley had said in interviews that they believed many nursing homes and adult homes could not withstand a surge of that level.

But Mr. Bloomberg, at a news conference on Oct. 26, announced: “At this point we are not — let me repeat that, not — recommending evacuations of these facilities.”

By Saturday night, the predictions were growing more dire, but Dr. Shah and Dr. Farley said they reconsidered but did not change their decision.

According to the Family Caregiver Alliance, 29% of the US population is classified as a caregiver to an incapacitated person. That is more than 65 million persons! About half of these unpaid caregivers also work full-time jobs and the majority of all caregivers report needing help with navigating medical care options and other logistic needs.

Fortunately, there are some mobile applications available to assist with some of these tasks. Aging in Place Technology Watch lists five such apps. Most of them are available for the iPhone, less for Android. Some of the prices are a bit absurd, in my opinion, so you may want to look them up in your app store and see what related items are available to you.

The researchers interviewed members of the pairs separately, asking questions related to how much value they place on five core values: autonomy, burden, control, family and safety. For example, one question focused on the level of importance a dementia patient gave to the ability to spend his or her own money in the way he or she wants.

“Our results demonstrate that adult children underestimate the importance that their relatives with dementia placed on all five core values,” said [lead researcher Steven] Zarit. “For example, the person with dementia might think it is very important to continue to be part of family celebrations, but his or her caregiver might not.”

So the caregivers/decision makers aren’t taking into account what the person with dementia values. That’s really sad.

The book is based on an intervention called cognitive stimulation, a dry academic name for something rich and human. The intervention supports things the person with dementia can do at any time, rather than trying prop up declining abilities. Helping people with dementia remain productive and connected helps mitigate the disease’s damaging byproduct: depression.

I Can Still Laugh focuses on a group of people with early-onset Alzheimer’s or other form of dementia. The group—mostly men, all professionally successful, all diagnosed in their 50s and 60s–called themselves the Stark Club, for their most dynamic member, whose donation also supported the research. Temple Stark was a loving guy with a big laugh and a sunny attitude who was diagnosed when he was 54 years old, a father of two teenage daughters at the peak of his career as an insurance underwriter. The book’s title is a quote from Temple.

My vote is still out on this one but it’s an important read, nonetheless. I know there probably are unnecessary tests done in the medical field but I’d hate for people to just stop because of an article like this or generalize to vaccinations, where one could have stemmed off an epidemic.

In my opinion, always get a second opinion.

New research shows how some common tests and procedures aren’t just expensive, but can do more harm than good.

Aug 14, 2011 10:00 AM EDT

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Dr. Stephen Smith, Professor emeritus of family medicine at Brown University School of Medicine, tells his physician not to order a PSA blood test for prostate cancer or an annual electrocardiogram to screen for heart irregularities, since neither test has been shown to save lives. Rather, both tests frequently find innocuous quirks that can lead to a dangerous odyssey of tests and procedures. Dr. Rita Redberg, professor of medicine at the University of California, San Francisco, and editor of the prestigious Archives of Internal Medicine, has no intention of having a screening mammogram even though her 50th birthday has come and gone. That’s the age at which women are advised to get one. But, says Redberg, they detect too many false positives (suspicious spots that turn out, upon biopsy, to be nothing) and tumors that might regress on their own, and there is little if any evidence that they save lives.

These physicians are not anti-medicine. They are not trying to save money on their copayments or deductibles. And they are not trying to rein in the nation’s soaring health-care costs, which at $2.7 trillion account for fully one sixth of every dollar spent in the U.S. They are applying to their personal lives a message they have become increasingly vocal about in their roles as biomedical researchers and doctors: more health care often means worse health. “There are many areas of medicine where not testing, not imaging, and not treating actually result in better health outcomes,” Redberg says. In other words, “less is more.” Archives, which is owned by the American Medical Association, has been publishing study after study about tests and treatments that do more harm than good.

Hypochondriacs often provide comic relief in TV and film (see stubbornly bedridden Cameron at the beginning of “Ferris Bueller’s Day Off” or Melman the anxious pill-popping giraffe in “Madagascar”). The doctor-patient relationship itself is also played for laughs: “Scrubs,” for instance, featured a recurring character named Harvey Corman whom an irritated Dr. Cox greets in one episode with his incurable bite: “And what imaginary disease is ailing you this time, my friend?” For a physician, these sorts of patients are frustrating to deal with, but not because their problem is a joke.

The social Web has a tendency to fold in on itself. Shortly after the launch of Google Plus, for example, users began to complain that it was only being used to talk about Google Plus. Drew Olanoff, currently the community manager for Get Satisfaction, would prefer that social networks revolved around their people instead of themselves. After being diagnosed with Hodgkin’s lymphoma in 2009, Olanoff built his experience into a Web phenomenon that offered connections, support, and some hopeful levity to people affected by cancer. His work is now bolstered by the launch of a new social network called I Had Cancer, which has created an engaging, Web-centric support system for cancer fighters, survivors, and their friends and family.

“Social” is an easy word to throw around these days. Olanoff wishes the Web didn’t take it so lightly. He’d prefer we talk about social good or social reform, rather than social media. “I don’t know what the phrase ‘social media’ means anymore,” he says. “I don’t think anybody does. I’ve always felt that what was missing [from that phrase] is the social part. The human aspect of it is severely lacking.”

The Institute of Medicine has named eight preventive services that women should get for free under the new health care law. Exactly how much money are we talking about? GOOD took stock of the money spent by a “typical” American woman whose sexual health and life choices correlated with the national averages. Turns out being a woman is pretty pricey.

What does society do when one person’s behavior puts the greater community at risk? That’s a no-brainer, right? We make them stop. We pass laws, or impose economic rules, or find other way to discourage individual behaviors that threaten the greater common good. You don’t get to drive drunk. You don’t get to smoke in public places. You don’t even get to leave your house if you catch some particularly infectious disease.

Then what should we do about people who decline vaccination for themselves or their children, and put the greater public at risk by fueling the resurgence of nearly eradicated diseases? Isn’t this the same thing, one person’s perception of risk producing behaviors that put others at risk? Of course it is. Isn’t it time for society to say that in the greater public interest, we need to regulate the risk created by the fear of vaccines? Yes. It is.

The evidence is overwhelming that declining vaccination rates are contributing to outbreaks of disease. Take just one example, measles. The WHO reports outbreaks in many countries where vaccination rates have gone down: As of June – France (12,699 cases in 2011, more than in all of 2010 already, including six deaths), Spain (2,261), Italy (1,500), Germany (1,193, one death), Switzerland (580), Romania, Belgium, Denmark, and Turkey. There have already been 550 measles cases in England and Wales this year compared with 33 all of last year.

The U.S. has seen 156 cases as of mid-June, compared to a total of 56 cases per year from 2001-2008. The CDC has an emergency health advisory out for measles, a disease officially declared eradicated in the United States in 2000.

Small numbers, you say? True, but consider their cost (beyond the suffering of the patients). Measles is ferociously infectious, and potentially deadly to the young or old or people with weakened immune systems, so it requires an intense response from the medical and public health communities. Consider just one small outbreak: When a woman from Switzerland who had not been vaccinated for measles visited Tucson and became symptomatic, she went in to a local hospital for medical attention and three months later at least 14 people, including seven kids, had gotten measles. Seven of the victims caught the disease while visiting health care facilities. Four people had to be hospitalized. The outbreak cost two local hospitals a total of nearly $800,000, and the state and local health departments tens of thousands more, to track down the cases, quarantine and treat the sick, and notify the thousands of people who might have been exposed.

Fueling the spread? None of the victims had been vaccinated, and, remarkably, 25% of the workers in the health care facilities where the patients were treated had no immunity to measles (either they had not been vaccinated or the antibodies from an earlier vaccination could no longer be detected in their blood stream.) One health care worker got the disease, and gave it to two other people.

That’s just one example of the growing threat to public health caused by people worried that vaccines will cause autism and other harms, despite overwhelming evidence to the contrary. In many places, particularly in affluent, liberal, educated communities (Boulder, San Diego), unvaccinated people are catching diseases that vaccines can prevent, like measles, whooping cough, and meningitis. In 2010 as California suffered its worst whooping cough outbreak in more than 60 years (more than 9,000 cases, 10 infant deaths), Marin County, one of the richest and most educated areas in California, had one of the lowest rates of vaccination statewide and the second highest rate of whopping cough. A 2008 study in Michigan found that areas with “exemption clusters” of parents who didn’t vaccinate their kids were three times more likely to have outbreaks of whooping cough than where vaccination rates matched the state average.

And this is a risk to far more people than just those who have opted out of vaccination. People are getting sick who have been vaccinated but the vaccine either doesn’t work or has weakened. (Of the 156 measles victims in the U.S. as of June, nearly one in five of them had been vaccinated but the vaccine didn’t work, or had weakened.) Infants too young to be vaccinated are getting sick, and some of them are dying, when exposed to diseases in communities where ‘herd immunity’ has fallen too low to keep the spread of the disease in check. Unvaccinated people are getting sick and visiting doctor’s offices or hospitals seeking treatment, raising the risk to anyone sharing those facilities, costing the health care system millions of dollars in avoidable expense, and costing local and state government (that’s taxpayer money, yours and mine) millions more as they try to chase down each outbreak and bring it under control, to protect the public’s health. Your health, and mine. (A recent economic analysis found that “…vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and $69 billion in total societal costs.

It is time to act in the face of this threat. This is not to deny the feelings of those who fear vaccines, or denigrate those fears as irrational, as many in the health care and vaccine communities too readily do. In fact, this is to recognize and respect the honest and powerfully deep roots of those fears, and the fact that no amount of communication or dialogue or reasoning can make people really worried about vaccines, stop worrying. Risk perception is ultimately subjective, a combination of the facts and how those facts feel. Sometimes our fears just don’t match the facts, and the gap between our feelings and the evidence, what I call “The Perception Gap”, produces real risks all by itself, risks which need to be managed the same way society tries to manage myriad other threats to public health from which we can’t protect ourselves as individuals.

There are many potential solutions, each fraught with pros and cons and details that require study and careful thought and open democratic discussion.

— Perhaps it should be harder to opt out of vaccination. (Twenty-one states allow parents to decline vaccination of their children simply for “philosophical” reasons. 48 allow a religious exemption but few demand documentation from parents to support claims that their faith precludes vaccination.)

— Perhaps there should be higher health care/insurance costs for unvaccinated people.

— Or we could do it in a positive way, with reduced health care/insurance costs for people who do get vaccinated, ‘healthy behavior’ discounts paid for by what society saves by avoiding the spread of disease.

— There could be restrictions on the community/social facilities unvaccinated people can use, or limits on the social activities in which they can participate, like lengthy school trips for kids, etc.

— Here’s an idea; vaccination, including boosters, should be required of anyone who wants to work in health care.

This is not about creating more government to intrude further into our lives. There is already too much of that. This is about calling on government to do what it’s there for in the first place, to protect us from the actions of others when we can’t protect ourselves as individuals. We do this in countless ways already. It is appropriate, and urgent, that we act to protect ourselves from those whose choices about vaccines are putting the rest of us at risk, and do the same thing society always does whenever one person’s behavior endangers the greater community. We make them stop.